SAN JUAN, Puerto Rico -- Having sepsis guidelines in place can speed time to antibiotic administration in children, researchers found.

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Note that in this study, for patients transferred to the ICU, the time from sepsis recognition to antibiotic administration was delayed in hospitalized inpatients compared with emergency department patients at least in part because there was a clinical sepsis guideline present in the emergency department but not on the inpatient floors.

SAN JUAN, Puerto Rico -- Having sepsis guidelines in place can speed time to antibiotic administration in children, researchers found.

In a single-center study, the mean time from an antibiotic order to administration of the drug was shorter in the ED -- where a guideline was in place -- than among inpatients (25 minutes versus 61 minutes, P<0.001), Scott Weiss, MD, of the Children's Hospital of Philadelphia, and colleagues reported during a poster session at the Society of Critical Care Medicine meeting here.

It also took less time between recognition of sepsis and issuance of the order for antibiotics for patients the ED than for inpatients (55 minutes versus 78 minutes), but the difference was not significant.

The overall difference in time from sepsis recognition to antibiotic administration (90 minutes versus 141 minutes, P=0.001) was driven by the difference in time from antibiotic order to administration, Weiss said.

Studies have shown that giving antibiotics within an hour of diagnosis can improve outcomes in severe sepsis and septic shock, and these parameters have been incorporated into guidelines in the Children's Hospital emergency department.

To see if there was a difference in time to antibiotic administration between the ED and clinical areas that did not have an antibiotic protocol in place, Weiss and colleagues assessed 117 consecutive patients with severe sepsis or who were in septic shock who were admitted to the pediatric ICU between February and October 2012 via either the ED (46) or from inpatient floors (71).

They found that those admitted from inpatient floors were significantly less likely to receive antibiotics in 60 minutes or less (OR 0.31, 95% CI 0.12 to 0.76).

That relationship remained even after controlling for critical chronic illness (OR 0.29, 95% CI 0.12 to 0.74).

But overall, only 22% of patients got antibiotics within 60 minutes regardless of where sepsis was first recognized.

The researchers noted that their study was limited by the fact that it was done in a single center and had a small sample size, but Weiss and colleagues still concluded that antibiotic administration is often delayed in pediatric inpatients with sepsis, largely because of hold-ups after drugs have been ordered.

Weiss said the findings suggest a need for sepsis protocols for pediatric inpatients just as there are in the ED. Future work could focus on determining whether a screening algorithm plus clinical guidelines can diminish the time to receiving antibiotics and can improve outcomes, he said.

Anand Kumar, MD, of the University of Manitoba in Winnipeg, who moderated the poster session, said clinicians should think closely about whether their antibiotic orders for critically ill patients are indeed being processed quickly.

Some clinicians may incorrectly assume that writing an antibiotic order in an ICU or an ED is automatically considered STAT by the pharmacist, Kumar said.

"At our [hospital], any first order of any intravenous antibiotic is automatically STAT," he said. "But before we did that, one in 20 of our cases wasn't being done STAT. They'd come in and wait 10 hours for a drug. It was crazy."

The researchers reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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